Confidentiality in Healthcare

1. Confidentiality in Healthcare

Ethics & Law
Muhamedzhan Raiymbek

2. Session Objectives

• What is confidentiality? /Why respect
confidentiality?
• The law
• Is confidentiality absolute/Exceptions to
confidentiality/Breeching confidentiality
• Confidentiality –Death, incapacity and minors
• Confidentiality - Palliative care case study

3. Confidentiality

• Generally, if
institution/person ‘A’ holds
information about person ‘B’
then person ‘C’ cannot obtain
that information in the
normal course of events
without the consent of person
‘B’
• ‘Most people consider health
information to be highly
personal and, therefore, need
to be confident that their
privacy will be protected
whenever they use a health
service ... Clear and open
communication between the
health service provider and
health consumer is integral to
good privacy’
Radwanshi (2001)

4. What information is confidential?

All identifiable patient information, whether written,
computerised, visual or audio recorded or simply held in the
memory of health professionals, is subject to the duty of
confidentiality.
It covers:
• Any clinical information about an individual’s diagnosis or
treatment
• A picture, photograph, video, audiotape or other images of the
patient
• Who the patient’s doctor is and what clinics patients attend
and when
• Anything else that may be used to identify patients directly or
indirectly.
(BMA 2008)

5. When does a matter become confidential?

Broadly speaking the courts have recognised
three elements to deciding whether a matter is
confidential:
• The nature of the information
• Nature of the encounter
• Nature of any disclosure

6. Why respect confidentiality?

• Trust is an important aspect between patients and
healthcare professionals. Patients without fear of a
breech of confidentiality should be able to
communicate symptoms that often they may feel are
embarrassing, stigmatising, or indeed trivial
• Without this trusting relationship patients may not
divulge information which may make treating them
impossible
• Patients may not seek medical attention at all
• Has important role in a professional patient
relationship establishing a sense of security,
freedom of action and self respect for patients

7. http://www.dataprotection.ie/viewdoc.asp?DocID=225 (2003)

8. Why respect confidentiality?

9. Why respect confidentiality?

• Hospital policy
▫ Contained within each member of staff contract of
employment
▫ Can result in disciplinary action

10. Why respect confidentiality?

• Professional Code of Conduct – An Bord
Altranais
‘Information regarding a patient’s history,
treatment and state of health is privileged and
confidential...’
‘Professional judgement and responsibility should
be exercised in the sharing of such information with
professional colleagues. The confidentiality of patient’s
records must be safeguarded.’
(http://www.nursingboard.ie/en/publications_current.as
px?page=4 )

11. The Irish Medical Council – Guide to Professional Conduct and Ethics

• ‘Confidentiality is a fundamental principle of medical
ethics and is central to the trust between patients and
doctors’
• ‘Patient information remains confidential even after
death’
• ‘You should ensure as far as possible that the patient’s
privacy is maintained at all times and that accidental
disclosure of confidential information does not occur’
• ‘You should ensure as far as possible that confidential
information in relation to patients is maintained
securely and in compliance with data protection
legislation’.

12. Why respect confidentiality?

The Data Protection Commissioner
Criminal sanctions
• Under section 31 of the Acts, the maximum fine on summary
conviction of such an offence is set at €3,000. On convictions on
indictment, the maximum penalty is a fine of €100,000.
Civil sanctions
Where a person suffers damage as a result of a failure by a data
controller or data processor to meet their data protection
obligations, then the data controller or data processor may be
subject to civil sanctions by the person affected. Ordinarily, the
"injury" suffered by a data subject will be damage to his or her
reputation, possible financial loss and mental distress.

13. Confidentiality Ethics and Law

14. Is the duty of confidentiality absolute?

15. Is confidentiality an absolute right?

• In Ireland confidentiality or privacy is
recognised by the courts as a right, but not an
absolute right
• The belief that confidentiality is not absolute is
also the model which our two closest neighbours
the U.S. and the U.K. subscribe to
• In France and Belgium confidentiality is
considered as an absolute requirement to protect
the patient’s interests

16. The exceptions to confidentiality

There are four circumstances where exceptions may be
justified in the absence of permission from the patient:
• (1) When ordered by a Judge in a Court of Law, or by a
Tribunal established by an Act of the Oireachtas.
• (2) When necessary to protect the interests of the
patient.
• (3) When necessary to protect the welfare of society.
• (4) When necessary to safeguard the welfare of another
individual or patient.
(https://medicalcouncil.ie/MediaCentre/Publications/Older/Ethical%20Guide%202004.
pdf )

17. When necessary to protect the interests of the patient

• Children or adults who are subject to abuse Child Care Act 1991, furnishes the Garda
Siochana with the power to evoke an emergency
care order if they believe there is an immediate
and serious risk to the health or welfare of a
child
• The protection of an individual from themselves,
in cases of suicide could also be broadly placed
in this category; this is where the limits of this
exception become vague

18. Case

‘Against all the odds, and despite being referred to a hospice, Collette showed
signs of recovering from bowel cancer. After several months, the
consultant decided that Collette was no longer terminally ill, although he
could not be certain that she would not become ill again in the future.
Accordingly, he felt she no longer required the extensive support supplied
by the hospice and discharged her. Collette was very upset by this, partly
because she did not want to loose her terminally ill status, which had
generated her more attention from her family than she had become
accustomed to in the past.
The hospice staff were not unsympathetic. They had promised that they
would not abandon her and would care for her until she died. The staff
also widely believed that her family had rather neglected her previously.
Because they did not wish to let Collette down, she was given radically
reduced honorary status as an out-patient. For instance she still attended
social events and had her hair set by the hair dresser who donated some of
her spare time to the hospice. It quickly became obvious that Collette’s
family did not realise that she was no longer thought to be terminally ill.
The nurse manager attempted to talk to Collette about this, but she was
politely and firmly told to mind her own business.’
(Webb 2005)

19. How can healthcare providers insure confidentiality is maintained

Discretion in general conversations
▫
‘New technology’: Facebook, Twitter
▫
Online posting of unprofessional content
(Katherine C. Chretien, et al. JAMA. 2009;302(12):1309-1315 Oct, 2009)
Examining how we talk to patients
▫
Out-side work
▫
With Non-clinical personnel:(confidentiality agreement)
How do we ‘carry’ data?
▫
Unsecured laptops
▫
USB keys
▫
Is data anonymised where possible
When information is shared – every party must be aware of his/her obligation of
confidentiality
Seek patient consent as early as is reasonably possible

20. Summary

• Confidentiality is VITAL in healthcare – But is not
always an absolute right
• There are 4 exceptions defined by the Irish medical
council
• A healthcare professional MUST be able to stand over
any breech of confidentiality and it should be a last
resort
• Duties to inform authorities in certain cases (Child
abuse, elderly abuse, public interest) – where danger
exists, should only be done after careful consideration
• All competent persons over 18 have the right to
confidentiality- for all other persons healthcare
providers must act in the patients best interests